The effects of family support, expectation of filial piety, and stress on health consequences of older adults with diabetes mellitus

Abstract

The primary purpose of this study was to test a theoretical model that proposed that the health consequences could be predicted by three key concepts: family support, expectation of filial piety, and stress. The health consequences studied were well-being and glycemic control. The secondary purpose of this study was to explore the meaning of well-being in order to develop a concept of well-being that is culturally specific.This study used a cross-sectional, correlational design with a causal modeling approach. A convenience sample (N = 150) of older Taiwanese with Non-Insulin Dependent Diabetes Mellitus (NIDDM) was used. Subjects completed four instruments indexing the four major theoretical concepts: family support, expectation of filial piety, perceived stress, and well-being. The other major concept, glycemic control, was indexed by biological marker: glycosylated hemoglobin. Multiple regression analysis and a path analysis were used for data analysis. The theoretical model was tested first using the whole sample and then by gender and educational subgroups. The qualitative data were collected in in-depth interviews with 12 subjects who were recruited from the 150 subjects, and stratified on gender and educational level. As predicted, in the path analysis of total sample, family support showed direct effects (B =.50) and indirect effects through perceived stress, on well-being (R$\sp2$ = 48) in reduced empirical model. Expectation of filial piety had no relationship with well-being. Gender had interactional effect on the relationship between family support and glycemic control. In men, the higher family support the better glycemic control. In women, the higher the family support, the worse the glycemic control. Content analysis of the qualitative data revealed that parents adjusted their expectation of filial piety to protect themselves from disappointment with filial care. This adjustment of expectation of filial piety helps explain why expectation of filial pity was not a significant predictor of well-being in the model. In addition, content analysis showed well-being consisted of five attributes: family support, finish all family obligation, sense of dignity, self-reliance, and extra familial support.Family support predicted well-being and glycemic control of the older adults with NIDDM in this study. This added further evidence of the importance of family support to the health of older adults. The findings suggest that clinical nursing interventions that facilitate family support and the adjustment of expectation of filial piety may improve health consequences of older adults with NIDDM. The effects of gender on the relationship between family support and health consequences require further investigation.